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A World War 2 Trilogy

By FRED NATH (Novelist and Neurosurgeon)

Fred's Blog

Blog

Covid-19 [3]

Posted on 29 March, 2020 at 5:54
So, we’ve hit the 1K mark for deaths. The PM says it’s going to get worse. We know this already. If we all behave and don’t touch anyone else, we may keep the deaths to a minimum but not before the death rate peaks.
Seems to me there is some pretty flawed thinking about who is at risk. Front-line NHS workers I suspect are among those who are most exposed to the Covid-19 virus. The Government is wanting to test them because… because what?
The average doctor in ITU whether he has PPE or not, may or may not have the virus at any one point in time. If he tests negative, he might become positive later today or tomorrow or the day after. Testing him now tells you nothing.
A front-line nurse in ITU may test positive – she drops out for 2 weeks.
 On her return we cannot know whether she is still infectious unless she is tested again.
It represents the pitfall of epidemiological statistical thinking. It doesn’t matter how many people have the virus what matters to the NHS staff is if they have had the virus or not. Once you have established who is immune, you have a workforce who can rest assured they are much less likely to get the illness again.
This why testing for the antigen isn’t much help unless you keep testing the same individuals. We have moved beyond the stage of contact tracing to try to confine the disease. We are now on damage limitation to limit the spread and the pressure on our 8000 ITU beds with ventilators.
Antibody testing may well be helpful but that is in any case, not completely reliable, since serum titres of the antibody are highest around 2 weeks after infection. So, if you return to work after a week’s isolation it is probably better to do the antibody test a week later – after the horse has bolted.
The WHO say test, test, test, but the timing is important and much depends on what stage we are at in the epidemic. For us now in the damage limitation phase, antibody testing is probably the most important.
There is a lot we still don’t know about this virus. From one description I read by someone who had the virus badly and survived, there is a an ‘allergic’ response after the initial temperature/cough phase and it is this which causes the severe form which starts days after the initial symptoms.
To quote a character in Full Metal Jacket: ‘It’s a big s**t sandwich and we all just gotta take a bite’.
I hope that no one who reads this gets the damn illness.

Stay home, stay safe.

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